Are you sure subcutaneous fluids twice a week is enough?
I've always given all of our CRF cats 100ml of lactated ringers solution each day.
How did the vet arrive at that figure of 75% function in one kidney? Such a measurement is darn near impossible to make.
All you can do is track the rise in BUN, Creatinine, and other indicators of renal health, or failure, in the bloodstream.
I've never heard of a vet giving a percentage figure as to how a CRF cat's kidneys were doing - but then, I've not heard it all by any stretch.
How does he know one kidney has failed completely? Has he done CAT, PET, or MRI scans to look at the physical state of the kidney.
Has he done biopsies? I really doubt any such figures the vet might quote.
All you can do is track the various blood substances to determine how the cat is doing.
What were the last BUN and Creatinine and how long ago where they measured?
I don't want to needlessly scare you, but the condition you are describing is that which we have seen in CRF cats in end stage disease.
Lethargy is a big sign. Vomiting and diarrhea are two more.
If this were one of our CRF cats, I'd get blood work done to check the BUN and Creatinine to guage kidney state and the various substances, potassium, calcium, etc. to judge metabolic state.
Unless we were concerned that his comfort level was low and that it might deteriorate overnight, we probably would not take a cat like this to the emergency, after hours clinic.
If we thought we should check his BUN, etc., that he might be in end stage and his comfort level was low, we would take him to the emergency clinic.
If he "crashed" we would take him to the emergency clinic.
If you are contemplating taking him to an after hours clinic, I would not worry about it being a "strange vet" - I doubt your cat will notice given how he is probably feeling right now. However, I do understand you being more comfortable with your vet who has been fighting with you to keep Marmalade as healthy as possible.
I keep looking back to your questions, to that "75% function of at least one kidney"
I keep coming back to that - how, the heck, did the vet arrive at such a statement?
If he is going on blood work results, he is guessing.
Extremely high - I mean HIGH - BUN and Creatinine are signs that the CRF has become ACF and the cat may be in end stage disease, but other than that, exact numbers don't mean a lot.
Diagnosis would have been made when they were quite high compared to the lab's reference range but subsequently you would look at trends in the values, not absolute numbers, judge whether the cat was was worsening or whether the treatment seemed to be holding back the flood waters.
I also go back to the twice weekly fluids - I have always given a CRF cat fluid daily.
If he is vomiting excessively and has diarrhea, he probably is dehydrated now. He might benefit from some fluids right now.
What type of fluids are you using. We always use lactated ringers.
CRF is always fatal, unless something else gets them first.
That is a fact that has to be accepted.
A cat with severely reduced renal function cannot live forever.
Renal failure is the number one cause of death in older cats - either directly, they die from it, or indirectly by euthanasia.
I have only what you have said and my own experience to go on, but I will leave you with this thought -
Thomas took a downturn on a Sunday when my wife was out of town.
He became lethargic and stopped eating. I gave him some Cyproheptadine http://en.wikipedia.org/wiki/Cyproheptadine to try and stimulate his appetite.
Our vet had prescribed this for him and another cat before. It can work like magic on cats who are not eating - our vet actually calls it Magic.
I gave it to him Monday mid-morning. The first dose had not effect and I gave him a second dose and he was eating that evening and seemed much better.
Tuesday he seemed better.
Early Wednesday morning, I found Thomas curled up in the bathroom sink - I've never seen another cat in the sink. He had gotten a little wet and his hair was stuck down and he looked emaciated. His tail was wet and the fur was all matted down - it looked like a rat's tail, a hairless rat's tail.
Sharon, my wife, arrived home about 2 hours later - say around noon or 1:00 PM. We decided to call the vet and schedule euthanasia for Thomas on Thursday afternoon.
Later that afternoon it became absolutely apparent - even to me ---- I had not been seeing what I was looking at for the past couple of days -- that we could not make Thomas suffer through another 24 hours.
We called our vet and found that he was not in (I knew he was out of town but had forgetting) There are about 8 or 9 vets at the animal hospital we go to - so we set up an appointment in about an hour, with another vet.
We got there and the vet wanted to take Thomas to the back to put a catheter in his leg, with which to administer the fatal injection.
They have done this before and each time the we could hear the cat crying out in pain.
I told them "No catheter, if you can't just inject it in his leg vein, give it to him interperitoneally - inject it into his abdomen."
Our Tom (a different cat - we just happened to have a Tom and a Thomas at one point, they were older cats, already named when we adopted them) had been euthanized (by a different vet at a different clinic) interperitoneally - the injection was made into his abdomen where it was absorbed into his bloodstream. It took Tom about 10 minutes to die, but he was unconscious after about 90 seconds or 2 minutes - he was in no pain.
I will not trade those last minutes I had with Tom for anything in the world!
Instead of the injection going into his leg vein and him collapsing a few second latter, I was able to sit and hold him as he slowly, peacefully, and painlessly slipped away.
It made no difference to him but it made a hell of a difference to me.
Instead of him instantly collapsing, dead, I was able to hold him for a few minutes, knowing the he was in no pain.
If this was paper I was writing on it would wet from the tears that are flowing down my face right now.
Back to Thomas - I told them no catheter - no more pain.
The vet said "I always use a catheter when I put a cat to sleep"
I told her, "Not this time."
You see, they want to put in the catheter because they know that a cat in the end stage of almost any disease will have collapsed veins and they don't want people to see them trying and trying to get the needle in the vein.
There is the practical side that sodium pentobarbital burns if not injected cleanly into the vein but the main reason is that they don't want you to see them hurting your child - I mean, cat.
We were at an impasse. I asked them to try and get our vet on his cell phone. I knew that he had been out of town the past couple of days but he was due back sometime that day.
Our vet once left the dinner table to come in and euthanize one of our cats who had crashed one evening (he had CRF also). That is the sort of person he is.
Anyway, they said the couldn't reach him. I told them they weren't using a catheter.
I was sitting there thinking that perhaps the only alternativce we had was to take Thomas home and return the next day and let out vet do it.
But I didn't want to put Thomas through that. Sharon later told me that she was just about ready to take him to the emergency clinic, that was the alternative she was thinking about.
It didn't think of that - had I thought of taking Thomas to the emergency clinic, we would have been, as they say, "OUT OF THERE.
The vet finally came back and gave Thomas a sedative subcutaneously at his shoulders.
I was holding Thomas when they did this and a couple of minutes laer I turned to my wife and asked if she wanted to hold him for a while.
SHe said yes, and I transferred him to her arms.
Maybe 3 minutes later she said "Bob, is he breathing? I think he is gone."
I leaned over him and put my ear against his chest and listened very carefully. There was no sound of heart or lungs.
The sedative had killed him - that was how far gone I had let him become.
He was so close to death that the god damn sedative killed him.
I should have made the decision on Monday to take him in and let him go. I should not have pushed with the Cyproheptadine to get him to eat.]
His action - or rather his inaction - was telling me, clearly, that it was time to let him go AND I IGNORED IT!
So, there is no way that I can tell you that it is Marmalade's time to leave, but please don't ignore the signs when the comes?
Okay?
I have a suggestion for when it comes -
Go out and buy some Sculpty clay and make an impression of Marmalade's paw just after he leaves for the Rainbow Bridge.
We started doing this with Thomas and I wish I had thought of it earlier.
I have no tangible items with which to remember Marco(GA), Tom(GA), Cleo(GA), Digby(GA), Simon(GA), and Taylor(GA) - except their ashes.
Those are our furry children that died before Thomas(GA).
The GA means, your choice, either Guardian Angel or Gone Ahead - as in gone ahead to wait for us at the Rainbow Bridge.
The clay I use for paw impressions is Sculpey II
I have tried other clays and have not had good results with them.
If you would email me via the email link at our web site on Feline Diabetes (the easiest way to get to the current site is via this link http://www.sugarcatsimon.com ) I will send you an email with full details about how to go about getting a good paw impression.
I don't have enough room here and the Yahoo Answers email facility also limits the size of messages.